| NPI | 1902895725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F9572) |
| Additional Taxonomies | 251K00000X Public Health or Welfare (Licence: TX F9572) |
| 261QA0005X Clinic/Center, Ambulatory Family Planning Facility (Licence: TX F9572) | |
| 261QP0905X Clinic/Center, Public Health, State or Local (Licence: TX F9572) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2024-09-23 |